Sex Differences in Stress Response: Classical Mechanisms and Beyond

Infant Maltreatment Induces Early Alterations in Adrenal Glands and Stress Response in Juvenile Rat Offspring

Chronic stressors, such as infant maltreatment during early development, can have long-lasting effects on an individual's health and stress-coping abilities across the lifespan. In this study, we applied the scarcity-adversity model (SAM) to Wistar rats from postnatal days (PND) 8 to 12 to evaluate the impact of scarcity condition on adrenal glands morphology and stress response in juvenile offspring (PND 21-35) of both sexes. Our results demonstrate that SAM exposure leads to significant alterations in the adrenal glands of offspring. Notably, the cortex-to-medulla ratio was reduced in SAM pups starting at PND 28. Morphological analysis of the adrenal cortex revealed an increased thickness of the undifferentiated zone, suggesting enhanced cell proliferation, alongside a transient reduction in the thickness of the zona fasciculata, where glucocorticoid-synthesizing cells are located. Additionally, we observed a reduction in the cytoplasmic diameter of zona fasciculata cells, coupled with an increase in the thickness of blood capillaries in this region in SAM offspring of both sexes. An increase in BrdU + cells in the cortex at PND 28 was observed in male SAM pups, but not in females. Endocrine assessments revealed a marked increase in corticosterone levels following stress induced by movement restriction in juvenile SAM offspring of both sexes. In conclusion, our findings underscore the significant impact of early-life stress on adrenal gland morphology and stress responsiveness, with potential long-term consequences for health and stress-coping mechanisms in offspring.

The COVID-19 Pandemic and the Gender Mental Health Gap

OBJECTIVE

To examine the relationship between the COVID-19 pandemic and the preexisting gender mental health gap in symptoms as well as service utilization.

STUDY SETTING AND DESIGN

Using repeated cross-sectional data, the study compares the gender mental health gap between American female and male college students before and after the start of the COVID-19 pandemic. Adjustments are made for preexisting trends. The study constructs an overall index of poor mental health, based on self-reported symptoms and service utilization related to anxiety, depression, and eating disorders. The gender mental health gap is also broken into the gender symptoms gap and the gender service utilization gap; each is analyzed separately by race, ethnicity, and sexuality.

DATA SOURCES AND ANALYTIC SAMPLE

The study draws on secondary data from the National College Health Assessment Surveys from fall 2015 to fall 2022 and focuses on young American college students, ages 18-25 years old.

PRINCIPAL FINDINGS

The gender mental health gap, measured using the overall index of poor mental health, increased by 15.6% [95% CI: 5.67-25.6]. The gender symptom gap in eating disorders increased by 38.8% [95% CI: 24.4-53.1] and is consistently observed across race, ethnicity, and sexuality, except among non-Hispanic Asian students. Minimal to no long-term significant differences are observed for the gender symptom gap in anxiety and depression. The gender service utilization gap, on the other hand, increased for all illnesses, with slight increases for anxiety and depression.

CONCLUSIONS

The COVID-19 pandemic was accompanied by an exacerbation of the already existing rise in eating disorders among female college students. In symptoms of anxiety and depression, the gap between women and men stayed constant during the pandemic. Action is required to understand and address the factors that led to a rise in the symptoms of eating disorders among women.

Steroidogenic acute regulatory protein mediated variations of gender-specific sex neurosteroids in Alzheimer's disease: Relevance to hormonal and neuronal imbalance

The steroidogenic acute regulatory (StAR) protein mediates the rate-liming step in neuro/steroid biosynthesis. Multifaceted and delicate changes during aging, disrupting hormonal and neuronal homeostasis, constitute human senescence, an inevitable phenomenon that attributes to increased morbidity and mortality. Aging, along with progressive decreases in bioactive neurosteroids, is the primary risk factor for Alzheimer's disease (AD), which preferentially impacts two-thirds of women and one-third of men. AD is neuropathologically characterized by the accumulation of extracellular amyloid-β and intracellular phosphorylated Tau containing neurofibrillary tangles, resulting in dementia. Postmortem brains pertaining to gender-specific AD patients exhibit varied suppression of StAR and sex neurosteroid levels compared with age-matched cognitively healthy subjects, in which the attenuation of StAR is inversely correlated with the AD pathological markers. Interestingly, retinoid signaling upregulates StAR-motivated neurosteroid biosynthesis and reinstates various neurodegenerative vulnerabilities that promote AD pathogenesis. This review summarizes current understanding of StAR-driven alterations of sex neurosteroids in gender-specific AD risks and provides biochemical and molecular insights into therapeutic interventions for preventing and/or alleviating dementia for healthy aging.

Perceived Health Needs, Social Support, and Depression Among Patients with Myocardial Infarction: A Cross-Sectional Study

BACKGROUND

Cardiovascular diseases are the leading cause of mortality globally. Myocardial infarction (MI), a major type of cardiovascular disease, presents long-term challenges for patients. Recognizing patients' perceived health needs and the factors that influence them is crucial for providing comprehensive care and improving outcomes.

AIM

This paper explores the perceived health needs, levels of depression, and social support among MI patients, as well as investigates the correlations between these factors.

METHODS

A cross-sectional study was conducted at King Salman Specialist Hospital from March to June 2024, enrolling 244 MI patients through convenience sampling. Data collection was performed using the following three validated questionnaires: the Cardiac Patient Learning Needs Inventory (CPLNI) to assess the learning needs of MI patients, the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression levels, and the Oslo Social Support Scale (OSSS-3) to measure social support. Statistical analysis was carried out using IBM SPSS Statistics, Version 27.

RESULTS

Patients aged 40 years or older and those who were employed exhibited greater learning needs (p < 0.001). Female patients were more depressed than males (p = 0.008). Higher social support was reported by the female patients, those with a family history of MI, and those who were employed (p = 0.002, 0.002, and 0.003, respectively). The total mean score for perceived learning needs was 3.72, with the highest needs in "other pertinent information", "medication information", and "anatomy and physiology". Depression was indicated in 45.1% of MI patients, with significantly higher depression levels in female than in male patients. Additionally, a significant positive correlation was found between social support and perceived learning needs (r = 0.205, p = 0.001), as well as a negative correlation between social support and depression (r = -0.441, p < 0.001).

CONCLUSIONS

Addressing both the physical and psychological needs is essential for MI patients. Comprehensive educational programs and mental health support services are necessary for improving outcomes. Personalized patient education and routine depression screenings should be integrated into post-MI care. Future research should examine longitudinal changes in learning needs and mental health status.

Genetic-epigenetic-neuropeptide associations in mood and anxiety disorders: Toward personalized medicine

Mood and anxiety disorders are complex psychiatric conditions shaped by the multifactorial interplay of genetic, epigenetic, and neuropeptide factors. This review aims to elucidate the intricate interactions among these factors and their potential in advancing personalized medicine. We examine the genetic underpinnings, emphasizing key heritability studies and specific gene associations. The role of epigenetics is discussed, focusing on how environmental factors can modify gene expression and contribute to these disorders. Neuropeptides, including substance P, CRF, AVP, NPY, galanin, and kisspeptin, are evaluated for their involvement in mood regulation and their potential as therapeutic targets. Additionally, we address the emerging role of the gut microbiome in modulating neuropeptide activity and its connection to mood disorders. This review integrates findings from genetic, epigenetic, and neuropeptide research, offering a comprehensive overview of their collective impact on mood and anxiety disorders. By highlighting novel insights and potential clinical applications, we underscore the importance of a multi-omics approach in developing personalized treatment strategies. Future research directions are proposed to address existing knowledge gaps and translate these findings into clinical practice. Our review provides a fresh perspective on the pathophysiology of mood and anxiety disorders, paving the way for more effective and individualized therapies.

A Selective Nuclear Factor-κB Inhibitor, JSH-23, Exhibits Antidepressant-like Effects and Reduces Brain Inflammation in Rats

BACKGROUND

Accumulating evidence suggests that nuclear factor (NF)-κB is involved in the pathophysiology of mood disorders.

OBJECTIVES AND METHODS

We conducted two experimental protocols in rats to investigate the effects of a selective NF-κB inhibitor (JSH-23) on (i) lipopolysaccharide (LPS)-induced inflammation and (ii) on behavioral phenotypes in rat models of depression (sucrose consumption test and forced swim test) and mania (amphetamine-induced hyperactivity test). Additionally, we tested the effects of JSH-23 on levels of inflammatory components (interleukin-6, prostaglandin E2, nuclear phospho-p65, and tumor necrosis factor-α) in the brain.

RESULTS

Acute treatment with JSH-23 (10 mg/kg, intraperitoneally [ip]) led to potent anti-inflammatory effects in LPS-treated rats, including a diminished hypothermic response to LPS and a reduction in pro-inflammatory mediators' levels in the brain. Chronic treatment with JSH-23 (3 mg/kg, ip, once daily, for 14 days) resulted in robust antidepressant-like effects (increased sucrose consumption and decreased immobility time). The antidepressant-like effects of JSH-23 were mostly accompanied by a reduction in levels of pro-inflammatory mediators in the brain. On the other hand, JSH-23 did not reduce amphetamine-induced hyperactivity.

CONCLUSIONS

Altogether, these data suggest that NF-κB may be a potential therapeutic target for pharmacological interventions for depression.

The glucocorticoid dose-mortality nexus in pneumonia patients: unveiling the threshold effect

Background

The impact of glucocorticoid use on mortality risk in pneumonia patients remains unclear. This study aimed to investigate the relationship between the accumulated dose of glucocorticoids (ADG) and secondary pneumonia mortality risk among patients receiving oral or intravenous glucocorticoids.

Methods

Data from the DRYAD database were analyzed, covering pneumonia patients from six academic hospitals over a 5-year period who had been administered oral or intravenous glucocorticoids. Piecewise linear regression and multivariate regression analysis were utilized to assess the association between ADG and mortality risk in pneumonia patients, while adjusting for potential confounders.

Results

Among the 628 pneumonia patients included, the 30-day mortality rate was 23.1% and the 90-day mortality rate was 26.4%. In the high-dose glucocorticoid group (≥24 mg/day of methylprednisolone or an equivalent glucocorticoid within 30 days before admission), the 30-day and 90-day mortality rates were 31.2% and 35.9%, respectively. Piecewise linear regression analysis demonstrated a non-linear relationship between ADG and mortality risk in pneumonia patients. Multivariate regression analysis revealed a significantly lower mortality risk in patients receiving an ADG of 20-39 g methylprednisolone compared to those receiving lower (<20 g) or higher doses (≥40 g), after adjusting for potential confounding factors. Additionally, in the high-dose glucocorticoid group, surpassing the inflection point of 20 g of methylprednisolone raised the 30-day and 90-day mortality risks (adjusted odds ratio, 95% confidence interval: 1.16, 1.03-1.30 and 1.23, 1.07-1.42, respectively). Notably, this threshold effect was observed exclusively in male patients.

Conclusion

This study provides evidence supporting a potential threshold effect between ADG and mortality risk in oral or intravenous glucocorticoid users with secondary pneumonia. Specifically, male patients receiving high-dose glucocorticoids should undergo close monitoring when the ADG of methylprednisolone exceeds 20 g, as it may be associated with an elevated risk of mortality.

Connecting the dots: sex, depression, and musculoskeletal health

Depression and multiple musculoskeletal disorders are overrepresented in women compared with men. Given that depression is a modifiable risk factor and improvement of depressive symptoms increases positive outcomes following orthopedic intervention, efforts to improve clinical recognition of depressive symptoms and increased action toward ameliorating depressive symptoms among orthopedic patients are positioned to reduce complications and positively affect patient-reported outcomes. Although psychosocial factors play a role in the manifestation and remittance of depression, it is also well appreciated that primary biochemical changes are capable of causing and perpetuating depression. Unique insight for novel treatments of depression may be facilitated by query of the bidirectional relationship between musculoskeletal health and depression. This Review aims to synthesize the diverse literature on sex, depression, and orthopedics and emphasize the potential for common underlying biological substrates. Given the overrepresentation of depression and musculoskeletal disorders among women, increased emphasis on the biological drivers of the co-occurrence of these disorders is positioned to improve women's health.

Prefrontal cortex-nucleus reuniens-hippocampus network exhibits sex-differentiated responses to stress and antidepressant treatment in rats

RATIONALE

Depression is a serious psychiatric disease, which is diagnosed twice as frequently in women than men. We have recently shown that lesioning or inactivation of the nucleus reuniens (RE), which interconnects the prefrontal cortex (PFC) and hippocampus, promoted resilience to stress in males, exerts an antidepressant effect in the Forced Swim Test (FST) and prevents the development of behavioral and neurobiological alterations induced by the chronic mild stress model of depression.

OBJECTIVES

In this study, we expand our findings on the FST in female rats and we investigate whether RE lesion presents sex differences following treatment with two distinct antidepressants, a selective serotonin reuptake inhibitor, i.e. sertraline and a tricyclic antidepressant, i.e. clomipramine.

METHODS

Male and female rats received either a surgical lesion of the RE or sham operation, then treated with vehicle, sertraline (10mg/kg) or clomipramine (10mg/kg) and were subjected to the FST. Activation of key brain areas of interest (PFC, Hippocampus and RE) were measured by c-Fos immunoreactivity.

RESULTS

RE lesion induced an antidepressant-like phenotype in both female and male rats, confirming its crucial role in the stress response. Similarly to RE lesion, sertraline treatment resulted in increased swimming and decreased immobility duration, as well as enhanced head shake frequency, in both sexes. Notably, climbing behavior was increased only following clomipramine treatment. RE area was less active in females compared to male rats and in clomipramine-treated males compared to their corresponding vehicle-group. Activation of the PFC and the CA1 hippocampal area was reduced in clomipramine-treated females, in comparison to vehicle-treated female rats. This effect was not evident in males, which exhibited less activation in the PFC and the hippocampus than females.

CONCLUSION

Re lesion proves equally effective in female and male rats, but sex is highlighted as a pivotal factor in behavioral and treatment response in FST, as well as in related circuit connectivity and activation.

Activation of CRF/CRFR1 Signaling in the Central Nucleus of the Amygdala Contributes to Chronic Stress-Induced Exacerbation of Neuropathic Pain by Enhancing GluN2B-NMDA Receptor-Mediated Synaptic Plasticity in Adult Male Rats

Exacerbation of pain by chronic stress and comorbidity of pain with stress-related disorders such as depression and post-traumatic stress disorder, represent significant clinical challenges. Previously we have documented that chronic forced swim (FS) stress exacerbates neuropathic pain in spared nerve injury (SNI) rats, associated with an up-regulation of GluN2B-containing N-methyl-D-aspartate receptors (GluN2B-NMDARs) in the central nucleus of the amygdala (CeA). However, the molecular mechanisms underlying chronic FS stress (CFSS)-mediated exacerbation of pain sensitivity in SNI rats still remain unclear. In this study, we demonstrated that exposure of CFSS to rats activated the corticotropin-releasing factor (CRF)/CRF receptor type 1 (CRFR1) signaling in the CeA, which was shown to be necessary for CFSS-induced depressive-like symptoms in stressed rats, and as well, for CFSS-induced exacerbation of pain hypersensitivity in SNI rats exposed to chronic FS stress. Furthermore, we discovered that activation of CRF/CRFR1 signaling in the CeA upregulated the phosphorylation of GluN2B-NMDARs at tyrosine 1472 (pGluN2BY1472) in the synaptosomal fraction of CeA, which is highly correlated to the enhancement of synaptic GluN2B-NMDARs expression that has been observed in the CeA in CFSS-treated SNI rats. In addition, we revealed that activation of CRF/CRFR1 signaling in the CeA facilitated the CFSS-induced reinforcement of long-term potentiation as well as the enhancement of NMDAR-mediated excitatory postsynaptic currents in the basolateral amygdala (BLA)-CeA pathway in SNI rats. These findings suggest that activation of CRF/CRFR1 signaling in the CeA contributes to chronic stress-induced exacerbation of neuropathic pain by enhancing GluN2B-NMDAR-mediated synaptic plasticity in rats subjected to nerve injury. PERSPECTIVE: Our present study provides a novel mechanism for elucidating stress-induced hyperalgesia and highlights that the CRF/CRFR1 signaling and the GluN2B-NMDAR-mediated synaptic plasticity in the CeA may be important as potential therapeutic targets for chronic stress-induced pain exacerbation in human neuropathic pain. DATA AVAILABILITY: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Pre-exercise cryotherapy reduces myoglobin and creatine kinase levels after eccentric muscle stress in young women

Introduction: The aim of this study was to investigate the effect of pre-exercise whole-body cryotherapy (WBC) on muscle damage indicators following eccentric treadmill exercise in young women. Methods: Twenty-seven participants underwent two 1-h downhill treadmill runs, replicating 60% of their maximal oxygen uptake, with a 4-week intermission for recovery and treatment application. In this intermission, one group underwent 20 sessions of WBC, delivered five times a week at -120°C for 3 min each, while the comparison group received no such treatment. Markers of muscle injury-serum myoglobin concentration, creatine kinase and lactate dehydrogenase activity and also uric acid, and cell-free DNA concentration-were measured before and after downhill runs. Results: The study observed a notable reduction in post-exercise myoglobin and CK levels in the WBC group after the second running session. Discussion: The results suggest that WBC can have a protective effects against muscle damage resulting from eccentric exercise.

Alzheimer's therapeutic development: shifting neurodegeneration to neuroregeneration

Alzheimer's disease (AD), similar to AD-related dementias, is characterized by impaired/lost neuronal structures and functions due to a long progression of neurodegeneration. Derailed endogenous signal pathways and disease processes have critical roles in neurodegeneration and are pharmacological targets in inducing neuroregeneration. Pharmacologically switching/shifting the brain status from neurodegeneration to neuroregeneration is emerging as a new therapeutic concept, one that is not only achievable, but also essential for effective therapy for AD. The results of the pharmacological-induced shift from neurodegeneration to neuroregeneration are twofold: arresting cognitive deterioration (and directing the brain toward cognitive recovery) in established AD, and preventing neurodegeneration through building up cognitive resilience in patients with preclinical or probable AD. In this review, we discuss these new developments in AD pharmacology and relevant clinical trials.